There need to be one more grade between Grade 1 and grade 2 .Grade 1 is defined as A velocity > E velocity . This is the commonest abnormal pattern and is often man made.We can’t help it . We have to report it anyway. Significant number of elderly show this pattern without any pathology. It simply represents augmented atrial contribution at times of apparent ventricular stress .

I wish a good chunk of grade 1 pattern , especially in elderly or during tachycardia should be labelled as physiological grade 1 pattern (or simply as normal variant ) . However I would prefer it to be named as pseudo abnormal pattern* !

*In my experience , currently medicine is taught in a complex manner .Facts that are told in simple terms are rejected straightaway . It would seem,too much clarity is not good for science So,let us get confused one more time for the sake of our patients !